1986, 01-30 Permit App: 00009541 Residence-44
5 3
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
" 1 sNanle/�� (last) (first) (m)
Departrr>ent Only
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Comm
2 Project Address of Mailing Address) *Road Name Space Zip
(-.T5 ZD l�0-0rr6e_ ku E, 957-- oe,
3 City mmunity
�v �" vim'
/S�t�ate
L�u� !f
Subdivision/Plat Name
4 Assessor Parcel No. \
7 54f 2 .3 '41(fOD.21c*.)
1
Lot
///
Block
S p YJ,^1.105
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. #
Zone
Project No. L
l
6 Dwell #
I
No, of Buildings
I
Sq. Ft./Acre
Depth
7-I
Frontage
611
7 Set Bads -Front
o'
(L)S-1(R2�
Rear f
1
Census Tract T
Module No.
I
Initials
VN M
.
k 16 Architect Firm Namej) �l
�/f!i.-�Yir�. - G1'i6i�'�I
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Contractor Firm Name
fs p- Zoic_
a>�'�ff-
Street
Address
O -fax /32l7
Zip
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Ciy
y
-✓v
State
Gl fi
Phone
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-2-2aaa
Contact Person v
icense No.
C;e6>EX
Z/kivZ—
Phone if different than above
( )
8 Owner/Agent (if different than #1 above)
g / 7 90
Business
Address
9 Zip
City
State
Phone
(
12 Review Required
Plan Check (YIN)
Other (Y/N)
1SEPAExempt
(Y/N)
Date
15 Type Work L Bldg
n Fire
G MH
E Demo
ISC
New
_ Add/Alter
7 Replace
7 Move
J Other
14 Describe Work
10 Applicant Name
Street
Address
11 Zip
City
State
Phone
(
Lender
/VL--V-C___ -
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information
u8 - 4
6. -- 316
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
DEPARTMENT APPROVALS
This is nota Permit
(Indicated approvals required In either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Health
W. 1101 College
Room 200 ❑ Additional structure;
/ �'
APPLICATION # 51-
(` , `/
❑ Commercial; ❑ Residential
❑ New Construction; ❑ Bldg alteration/addition
Conditions/Comments•
Release
Release
w/cond 1
Hold 2
rin
11111
Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson ❑ Setbacks; ❑ lot w/d; El lot size; ❑ use/zone;
Cl CU, variance, zone change; shoreline; El fence;
❑ Other
Conditions/Comments: 2. 5 ( ' Yel-4- 5t1-1
� - 73
Engineers: ❑ Commercial; ❑ Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage r new access/approach; 0 fence;
0 road improvements
Conditions/Comments•
//1/4- - 4a /
Utilities:
N. 811 Jefferson
Conditions/Comments•
Other:
Plan Exam
Fire Prev.
Conditions /Comments'
Project Representative Telephone
Agencies Performing Special Inspection:
1
2
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
FULL REAL ESTATE SERVICE
QUALITY CONSTRUCTION • LAND DEVELOPMENT
TEL. 922-2200 • N. 1506 PINES ROAD • SPOKANE, WA. 99206
ZIOSBY
alTERPRISES
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